TY - JOUR
TI - Successful management of adhesion related small bowel ischemia without intestinal resection: A case report and review of literature.
AU - Vassiliu, Pantelis
AU - Ntella, Vasiliki
AU - Theodoroleas, George
AU - Mantanis, Zisis
AU - Pentara, Ioanna
AU - Papoutsi, Eleni
AU - Mastoraki, Aikaterini
AU - Arkadopoulos, Nikolaos
JO - World journal of gastrointestinal pathophysiology
PY - 2019
VL - 10
TODO - 2
SP - 29--35
PB - 
SN - null
TODO - 10.4291/wjgp.v10.i2.29
TODO - Case report, Conservative surgical approach, Intestinal ischemia, Intraabdominal adhesions, Small bowel obstruction, Vacuum-pack technique
TODO - BACKGROUND: Intraabdominal adhesions develop spontaneously or after an inflammatory process or surgical procedure in the abdomen. They are the most common cause of  small bowel obstruction (SBO). SBO occasionally leads to intestinal ischemia (InIs)  which can be a life-threatening condition that requires management as soon as  possible. We herein report a case of SBO with InIs presented in our institution and  treated without intestinal resection. CASE SUMMARY: A 34-year-old man presented at  the emergency department after a 12-h-onset diffuse abdominal pain, bloating and  nausea. He had a history of traumatic right hepatectomy 11 years ago as well as  adhesiolysis and resection of a long part of small bowel 2 years ago. An abdominal  computed tomography (CT) showed dilated loops that led to the diagnosis of SBO. Due  to deteriorating lactic acidosis, the patient was operated. Torsion of the small  bowel around an adhesion led to 2.30 m of ischemic ileum. After the application of  N/S 40 °C for 20 min, the intestine showed signs of improvement and it was decided  to avoid resection and instead temporary close the abdomen with vacuum-pack  technique. At the second-look laparotomy 48 h later, the intestine appeared normal.  The patient was discharged on the 8th post-op day in excellent condition.  CONCLUSION: In case of SBO caused by adhesions, extreme caution is needed if InIs is  present, as the clinical signs are mild and you should rely for diagnosis in CT  findings and lactate levels. Conservative surgical approach could reverse the  effects of InIs, if performed quickly, so that intestinal resection is avoided and  should be used even when minimum signs of viability are present.
ER -